CENTRACARE HEALTH SYSTEM (NPI# 1083164255) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083164255 |
| Entity Type | Organization |
| Organization Name | CENTRACARE HEALTH SYSTEM |
| Other Organization Name | CENTRACARE HEALTH COMMUNITY PARAMEDIC |
| Practice Address |
1406 6th Ave N Saint Cloud MN 56303-1900 |
| Practice Telephone | 3202512700 |
| Practice Fax Number | 3202555711 |
| Mailing Telephone | 3202512700 |
| Mailing Fax Number | 3202555711 |
| Enumeration Date | 2016-10-11 |
| Last Update Date | 2017-04-05 |
| Authorized Official Name | GREGORY R KLUGHERZ (VICE PRESIDENT AND CFO) |
| Authorized Official Telephone | 3202555665 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | RR MEDICARE | 6900009424 | 01 |
| MN | 443985600 | 05 |
| Other Name | Type Code |
|---|---|
| CentraCare Health Community Paramedic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457901506 | Centracare Health System | Emergency Medicine | 121 Lake St N, Big Lake, MN 55309-9254 | 2019-09-19 |
| 1669807897 | Centracare Health System | Clinic/Center | 1900 Centracare Cir, Saint Cloud, MN 56303-5000 | 2013-09-06 |
| 1215118989 | Centracare Health System | Home Health | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2007-11-21 |
| 1598713075 | Centracare Health System | Clinical Medical Laboratory | 1900 Centracare Cir, Centracare Health Plaza, Saint Cloud, MN 56303-5000 | 2006-05-05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | CENTRACARE HEALTH SYSTEM | 1406 6th Ave N, Saint Cloud, MN 56303-1900 |
| System for Award Management (SAM) Entities | CENTRACARE HEALTH SYSTEM-SAUK CENTRE | 425 Elm St N, Sauk Centre, MN 56378-1010 |
| Street Address |
1406 6TH AVE N |
| City | SAINT CLOUD |
| State | MN |
| Zip Code | 56303-1900 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336149939 | Ralph E Fedor | Radiology | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2005-07-26 |
| 1558962399 | Amanda Lee King | Nurse Practitioner | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2020-11-06 |
| 1912512302 | Fadumo Hassan | Registered Nurse | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2020-09-11 |
| 1083228092 | Kristin Deneille Hazeman | Registered Nurse | 1406 6th Ave N, Saint Cloud, MN 56303-1901 | 2020-09-07 |
| 1508477845 | Taylor Dean Olson | Registered Nurse | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2020-08-11 |
| 1407467749 | Traci Jo Salveson | Registered Nurse | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2020-08-11 |
| 1487264164 | Cameron Charles Hendrickson | Registered Nurse | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2020-08-06 |
| 1154931475 | Megan Ann Brown | Nurse Practitioner | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2020-08-01 |
| 1326657255 | Amanda J Dircks | Registered Nurse | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2020-07-27 |
| 1003439241 | Mary Elizabeth Amundson | Registered Nurse | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2020-05-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841800463 | Daniel P Lahr | Radiologic Technologist | St Cloud Va Health Care System, 4801 Veterans Drive, St Cloud, MN 56303 | 2020-08-07 |
| 1730798398 | County of Stearns | Case Management | 705 Courthouse Square, St Cloud, MN 56303 | 2020-07-29 |
| 1669007126 | Aflah Transportation LLC | Non-emergency Medical Transport (VAN) | 3316 3rd Street North, Suite 129, Saint Cloud, MN 56303 | 2020-03-05 |
| 1609420942 | Stephanie Lynne Metzger | Nurse Practitioner | Centracare Clinic Riverc Ampus/nephrology, 1200 Sixth Ave North, St. Cloud, MN 56303 | 2019-07-25 |
| 1306406947 | Willow Tree Acupuncture LLC | Acupuncturist | 203 Cooper Ave N Suite 160, St. Cloud, MN 56303 | 2019-06-17 |
| 1821553520 | Alan Melvin Hoeper | Nurse Anesthetist, Certified Registered | Centracare Clinic Anesthesiology, 3701 12th St N, Suite 202, St. Cloud, MN 56303 | 2019-02-06 |
| 1437644465 | Brianna Larissa Justin | Speech-Language Pathologist | St. Cloud Hospital, 1406 6th Avenue N, St. Cloud, MN 56303 | 2018-06-22 |
| 1780186486 | Simplicity Health Pa | Family Medicine | 1511 Northway Dr Ste 103, Saint Cloud, MN 56303 | 2018-03-08 |
| 1639682925 | Dereje Beyene | Respiratory Therapist, Certified | 1406 15th Street North, Saint Cloud, MN 56303 | 2017-11-09 |
| 1740792761 | Lisa Ann Horner | Nurse Practitioner | 1555 Northway Drive #110, Centracare Complex Care Clinic, St Cloud, MN 56303 | 2017-10-31 |
| Find all providers in zip 56303 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780295618 | Unutrition LLC | Clinic/Center | 500 Moonlight Ct, Saint Cloud, FL 34771-9062 | 2020-08-13 |
| 1770115537 | Therapy World LLC | Clinic/Center | 4111 Neptune Rd, Saint Cloud, FL 34769-6741 | 2020-02-10 |
| 1285198663 | Center for Life Transitions | Clinic/Center | 38 24th Ave N, Saint Cloud, MN 56303-4340 | 2019-01-30 |
| 1720561087 | Ideal Option, Pllc | Clinic/Center | 451 E Saint Germain St Ste 200, Saint Cloud, MN 56304-0759 | 2018-09-12 |
| 1164978219 | Centracare Clinic | Clinic/Center | 3701 12th St N, Suite 100, Saint Cloud, MN 56303-2255 | 2016-08-29 |
| 1821471962 | Breath of Life Diagnostics | Clinic/Center | 3505 Progress Ln, Saint Cloud, FL 34769-6519 | 2015-07-07 |
| 1669807897 | Centracare Health System | Clinic/Center | 1900 Centracare Cir, Saint Cloud, MN 56303-5000 | 2013-09-06 |
| 1275818858 | Abdul B Lodhi Md Pa | Clinic/Center | 1600 Budinger Ave Ste A, Saint Cloud, FL 34769-6007 | 2011-10-14 |
| 1982937827 | Keith Larson Neurology Pllc | Clinic/Center | 1511 Northway Dr, Suite 202, Saint Cloud, MN 56303-1261 | 2009-09-10 |
| 1679708887 | Iris Vision Care, LLC. | Clinic/Center | 1301 33rd St S, Suite 104, Saint Cloud, MN 56301-9668 | 2009-05-18 |
| Find all providers in SAINT CLOUD | ||||
| City | SAINT CLOUD |
| Zip Code | 56303 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.